{"id":"F2022L01373","name":"Statement of Principles concerning diaphragmatic hernia (Reasonable Hypothesis) (No. 99 of 2022)","slug":"statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441564,"registerId":"F2022L01373-fast-fetch-1775956834696","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning diaphragmatic hernia (Reasonable Hypothesis) (No. 99 of 2022)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nDIAPHRAGMATIC HERNIA (Reasonable Hypothesis)\n\n(No. 99 of 2022)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 21 October 2022\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
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Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning diaphragmatic hernia (Reasonable Hypothesis) (No. 99 of 2022).\n\n2 Commencement\n\n This instrument commences on 21 November 2022.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about diaphragmatic hernia and death from diaphragmatic hernia.\n\nMeaning of diaphragmatic hernia\n\n(2) For the purposes of this Statement of Principles, diaphragmatic hernia:\n\n(a) means an acquired protrusion of intra-abdominal tissue through the diaphragm into the thoracic cavity; and\n\n(b) excludes:\n\n(i) congenital diaphragmatic hernia;\n\n(ii) eventration of the diaphragm; and\n\n(iii) hiatus hernia.\n\nDeath from diaphragmatic hernia\n\n(3) For the purposes of this Statement of Principles, diaphragmatic hernia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's diaphragmatic hernia.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that diaphragmatic hernia and death from diaphragmatic hernia can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n8 Factors that must exist\n\nAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting diaphragmatic hernia or death from diaphragmatic hernia with the circumstances of a person's relevant service:\n\n(1) having a surgical procedure that involves the affected region of the diaphragm, excluding the oesophageal hiatus, within the 10 years before the clinical onset of diaphragmatic hernia;\n\nNote: Examples of surgical procedures that can involve the affected region of the diaphragm include liver resection, debulking surgery in ovarian cancer, nephrectomy, biopsy of a lesion on the diaphragmatic peritoneum and coronary artery bypass grafting.\n\n(2) having acute trauma to the affected region of the diaphragm before the clinical onset of diaphragmatic hernia;\n\nNote: Examples of acute trauma include falling from a height, motor vehicle accidents and gunshot or stab wounds.\n\n(3) having acute elevation of pressure within the abdominal cavity due to any one of the following:\n\n(a) Heimlich manoeuvre;\n\n(b) significant coughing;\n\n(c) significant physical effort; or\n\n(d) underwater diving with compressed air;\n\nwithin the 7 days before the clinical onset of diaphragmatic hernia;\n\n(4) having endometriosis involving the affected region of the diaphragm before the clinical onset of diaphragmatic hernia;\n\n(5) having a surgical procedure that involves the affected region of the diaphragm, excluding the oesophageal hiatus, within the 10 years before the clinical worsening of diaphragmatic hernia;\n\nNote: Examples of surgical procedures that can involve the affected region of the diaphragm include liver resection, debulking surgery in ovarian cancer, nephrectomy, biopsy of a lesion on the diaphragmatic peritoneum and coronary artery bypass grafting.\n\n(6) having acute trauma to the affected region of the diaphragm before the clinical worsening of diaphragmatic hernia;\n\nNote: Examples of acute trauma include falling from a height, motor vehicle accidents and gunshot or stab wounds.\n\n(7) having acute elevation of pressure within the abdominal cavity due to any one of the following:\n\n(a) Heimlich manoeuvre;\n\n(b) significant coughing;\n\n(c) significant physical effort; or\n\n(d) underwater diving with compressed air;\n\nwithin the 7 days before the clinical worsening of diaphragmatic hernia;\n\n(8) having endometriosis involving the affected region of the diaphragm before the clinical worsening of diaphragmatic hernia;\n\n(9) being obese for at least the 2 years before the clinical worsening of diaphragmatic hernia;\n\nNote: being obese is defined in the Schedule 1 – Dictionary.\n\n(10) being pregnant within the 6 weeks before the clinical worsening of diaphragmatic hernia;\n\n(11) inability to obtain appropriate clinical management for diaphragmatic hernia.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 8(5) to (11) apply only to material contribution to, or aggravation of, diaphragmatic hernia where the person's diaphragmatic hernia was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 8 applies in relation to a person; and\n\n(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 5\n\n1 Definitions\n\nIn this instrument:\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\n diaphragmatic hernia—see subsection 6(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument appears to be a standard, purpose-built Statement of Principles for a specific medical condition. It follows the established template for Repatriation Medical Authority determinations under section 196B(2) of the VEA, with the typical structure of: definition, factors for onset, factors for worsening, relationship to service provisions, and dictionary. There is no evidence of scope creep; it addresses exactly what it purports to cover — the connection between diaphragmatic hernia and military service for compensation purposes."},"complexity_factors":["Moderate cross-referencing between main sections and Schedule 1 dictionary (7 defined terms)","Dual structure covering both 'clinical onset' (factors 1-4) and 'clinical worsening' (factors 5-11) with overlapping but distinct factor sets","Nested definitions requiring calculation (BMI formula with mathematical notation W/H²)","Conditional logic in Section 9(2) restricting factors 5-11 to aggravation cases where condition pre-existed service","Incorporation by reference mechanism in Section 10 linking to other Statements of Principles","Specific temporal limitations (10 years, 7 days, 2 years, 6 weeks) that must be precisely calculated","Exclusion clauses in the definition (congenital, eventration, hiatus hernia) that narrow scope"],"plain_english_summary":"This Statement of Principles sets the medical rules for when acquired diaphragmatic hernia (not congenital or hiatus hernia) can be linked to Australian military service for compensation claims. It applies to veterans, current and former defence members, peacekeepers, and claimants under the VEA and MRCA.\n\nIt identifies specific medical and service-related factors (e.g., surgery, trauma, sudden abdominal pressure, pregnancy, obesity) that, if proven, create a reasonable hypothesis that service caused or worsened the condition—guiding entitlement decisions."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"The instrument itself defines its scope: it applies to acquired diaphragmatic hernia (with specific exclusions) and death contributed to by that condition (s6), and only to claims under the specified VEA/MRCA provisions (s4). The text contains no indication that it alters or expands scope beyond these stated limits."},"complexity_factors":["Multiple medical and temporal thresholds to prove connection: 10-year, 7-day, 6-week and 2-year windows that apply to different factors (see s8(1),(3),(5),(7),(9),(10)).","Distinction between clinical onset and clinical worsening, and separate applicability rules for pre-existing hernia aggravated by service (s8; s9(2)).","Explicit exclusions and definitional limits (congenital diaphragmatic hernia, eventration, hiatus hernia) that narrow scope (s6(2)).","Mixture of objective and subjective evidentiary matters — e.g. BMI calculation for 'being obese' (Schedule) versus 'inability to obtain appropriate clinical management' (s8(11)).","Cross-references to other Statements of Principles when a factor refers to a different injury/disease, requiring application of another instrument (s10).","Application limited to claims under particular statutory provisions (s4), creating a legal gate for which claim streams this SOP governs.","Requirement that any listed factor be related to the person's 'relevant service' (s9(1)), which imports statutory categories (Schedule definitions of 'relevant service').","Death definition includes a list of terminal events (Schedule) requiring causal linkage for fatality claims."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide whether an acquired diaphragmatic hernia (excluding congenital, eventration and hiatus hernia) — or death to which it contributed — can be reasonably linked to a person’s relevant service. It applies to veterans and service members claiming under specified VEA/MRCA provisions and requires at least one listed factor (e.g. recent diaphragm surgery, acute trauma, pressure events, endometriosis, obesity, pregnancy, or lack of appropriate management) that is related to their service (ss4,6–9)."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022","history":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-diaphragmatic-hernia-reasonable-hypothesis-no-99-of-2022/documents"}}